Healthcare Provider Details

I. General information

NPI: 1376876813
Provider Name (Legal Business Name): JESSICA A HUFF LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MELLEN ST
CENTRALIA WA
98531-1173
US

IV. Provider business mailing address

1101 MELLEN ST
CENTRALIA WA
98531-1173
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-1800
  • Fax: 360-330-5866
Mailing address:
  • Phone: 360-330-1800
  • Fax: 360-330-5866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA60092698
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: